The invention relates to apparatus serving to stretch skin so as to cover an open wound and to enable the surgeon to suture together the opposite skin margins. It relates especially to apparatus to be used during operations following wide excision of skin lesions or for closure of skin defects or otherwise damaged skin areas, thereby obviating the conventional method of using local skin flaps or grafting of skin from other body portions.
U.S. Pat. No. 4,896,680, by one of the present inventors, Bernard Hirshowitz, describes a method and apparatus for stretching the skin over a wound by load cycling including applying a pulling force on opposite skin margins during several periods interrupted by relaxation periods. In this way the skin can be stretched over a wide area in a manner not previously used until the invention by Bernard Hirshowitz. The above patent discloses a surgical stretching apparatus which comprises two pins to be inserted into the skin along both edges of the wound which are gradually pulled together by means of a flexible strap. According to the invention the pulling is done in intervals to allow the collagen fibres of the skin to rearrange themselves for further stretching. The pins of the described apparatus are more or less in the shape of safety pins each provided with a loop for attachment to the flexible strap; the strap, for its part, has projections or apertures for engagement with a ratchet-shaped device which will hold the two pins in forceful apposition.
It has, however been shown that the described apparatus has certain drawbacks which should be overcome by the present invention, the main drawback being that after the two pins have been drawn together, they do not leave room for suturing the approximated skin margins. Another drawback is that manual pulling on the flexible strap is rather crude, in that the pulling force cannot be minutely controlled. And finally that the two pins grip only relatively narrow strips of skin along both edges, thereby not permitting closure of a wide wound by one pulling operation.
It is, therefore, an object of the invention to provide an apparatus which will permit suturing together of the skin edges while the stretching apparatus is in situ without disturbing the suturing operation.
It is another object to permit insertion into the skin edges of longer pins adapted to grip practically the entire length of the wound and to permit shifting of the stretching means along the wound edges thereby enabling the two pins to be engaged in different locations.
And it is a further object to permit prolonged use of the apparatus as well as the pins, contrarywise to the apparatus described in the previous patent which had to be disposed after one use.